Hearing Devices Policy and Administration Manual€¦ · Hearing Devices Policy and Administration Manual 8 February 2016 Hearing Aids; Teletypewriters (TTY) for the Deaf or Speech

Ministry of Health & Long-Term Care

Hearing Devices Policy and Administration Manual

Assistive Devices Program

Ministry of Health & Long-Term Care

February 2016

www.health.gov.on.ca/adp

http://www.health.gov.on.ca/adp

Hearing Devices Policy and Administration Manual 2 February 2016

Table of Amendments This page will list all substantive changes to policies and procedures listed in the Manual.

Section Change Date

1000 Clarified Vendor Status August 13, 2015

510 Added service delivery model for BAHA abutment only May 1, 2015

710, 715 Updated prices for BAHA Replacement Sound

Processors, Abutments and Teletypewriters (TTY) May 1, 2015

605 Updated designated funding period for hearing aids May 1, 2015

100 Added manufacturers/distributors of devices as

intended target audience October 1, 2014

200 Added requirement that manufacturers/ distributors

provide invoices October 1, 2014

205 Added manufacturer warranty requirements October 1, 2014

210 Clarified removal of listed devices October 1, 2014

215 Clarified device pricing reviews October 1, 2014

805 Physician changed to prescriber April 1, 2014


Table of Contents Table of Amendments ......................................................................................................... 2

Table of Contents ................................................................................................................ 3

Part 1: Hearing Devices Policy and Administration Manual ............................................ 7

100 Purpose of the Manual .............................................................................................. 7

105 Protecting Personal Health Information .................................................................... 8

110 Definitions ................................................................................................................ 8

115 Roles and Responsibilities ........................................................................................ 9

Part 2: Devices Covered by ADP ..................................................................................... 16

200 Devices Covered .................................................................................................... 16

205 Hearing Aids/FM Systems ...................................................................................... 17

210 Cochlear Implant Replacement Speech Processors ............................................... 17

215 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors ................... 17

220 Teletypewriters (TTY) for the Deaf or Speech Impaired .......................................... 17

225 Items Not Funded by ADP ...................................................................................... 18

230 Repairs/Batteries ................................................................................................... 18

Part 3: Applicant Eligibility Criteria for Hearing Devices .............................................. 20

300 Basic Hearing Device Requirements ....................................................................... 20

305 Non-Eligible Hearing Device Requirements ............................................................ 21


310 Individual Identified Ineligible by Authorizer ............................................................ 21

315 Applicant Identified Ineligible by ADP ...................................................................... 21

Part 4: Confirmation of Eligibility for Devices Required ............................................... 23

400 Hearing Aids ........................................................................................................... 23

405 FM Systems ........................................................................................................... 23

410 Cochlear Implant Replacement Speech Processor ................................................. 24

415 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processor ..................... 25


Part 5: Service Delivery Models for Hearing Devices .................................................... 28

500 Hearing Aids and FM Systems ................................................................................ 28

505 Cochlear Implant Replacement Speech Processor ................................................. 31

510 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processor ..................... 32


Part 6: Device Eligibility ................................................................................................... 35

600 Number of Devices Funded and Designated Funding Periods ................................ 35

605 Designated Funding Periods ................................................................................... 36

610 Request for a Replacement Device......................................................................... 37

Part 7: Funding and Payment .......................................................................................... 40

700 Policies ................................................................................................................... 40

705 Approved Price for Hearing Aids (Includes FM Systems) ........................................ 40

710 Funding Amount for ADP Clients ............................................................................ 40


715 Funding for Ministry of Community and Social Services (MCSS) Benefits Recipients .

............................................................................................................................. 42

720 Delivery of Device ................................................................................................... 43

725 Expiry Date of the Application for Funding Hearing Devices .................................... 43

730 Hearing Aids/FM System Dispensing Fee Charges ................................................. 43

735 Pricing of Other Items............................................................................................. 44

Part 8: Invoicing Procedures ........................................................................................... 46

800 Invoice Processing.................................................................................................. 46

805 ADP Processing Errors ........................................................................................... 46

810 Authorizer Errors & Omissions ................................................................................ 46

815 Applicant Return of Hearing Devices ...................................................................... 47

820 Update Policy ......................................................................................................... 47

Part 9: Authorizers ........................................................................................................... 49

900 Authorizer Status .................................................................................................... 49

905 Requirements for Authorizer Status ........................................................................ 49

910 General Authorizer Policies .................................................................................... 51

Part 10:Vendors ................................................................................................................. 51

1000 Vendors Status ....................................................................................................... 53

1005 Staffing Requirements for Vendors ......................................................................... 54

1010 Additional Requirements – Hearing Aid Vendors ................................................... 56

1015 General Vendor Policies ......................................................................................... 56


Introduction

1


Part 1: Introduction to Hearing Devices Policy and Administration Manual

100 Purpose of the Manual The purpose of this Manual is to present the policies and procedures for ADP

funding of hearing Devices in one document. The Devices are:

Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors;

Cochlear Implant Replace Speech Processors;

Hearing Aids (including FM systems); and

Teletypewriters (TTY) for the Deaf or Speech Impaired.

This Manual is intended to complement the Policies and Procedures Manual for

the Assistive Devices Program (ADP Manual).

This Manual forms part of the agreement between the Ministry of Health and

Long-Term Care and the Vendor, and the agreement between the Ministry of

Health and Long-Term Care and the Authorizer. The Ministry reserves the right

to revise this Manual.

100.01 Intended Target Audience

This Manual is intended to be used by Authorizers and Vendors who have an

entered into an agreement with the Assistive Devices Program (ADP) to provide

Devices and services related to:

Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors;

Cochlear Implant Replacement Speech Processors;


Hearing Aids;

Teletypewriters (TTY) for the Deaf or Speech Impaired.

This Manual may also be useful to prescribers and dispensers with a role in

hearing devices.

105 Protecting Personal Health Information Authorizers and Vendors must comply with all applicable privacy laws governing

information regarding their Clients.

See the ADP Manual, Policy 700, Protection of Personal Information and

Personal Health Information.

110 Definitions Capitalized terms used in this Manual have the meaning associated with them

as set out in the ADP Manual or such meanings as described below:

110.01 Adult means any person 19 years of age or older.

110.02 Audiologist means a professional who holds a valid certificate of registration

from the College of Audiologists and Speech-Language Pathologists of Ontario

(CASLPO) and licensed to practise in Ontario.

110.03 Authorizer means an Audiologist or a hearing instrument specialist as

described in this Manual, Policy 905, Requirements for Authorizer Status or a

Speech-Language Pathologist who has met all registration requirements with

the Program and holds an executed Authorizer Agreement with the Program.

110.04 Child means any person 18 years of age or younger.


110.05 Manual means this Hearing Devices Policy and Administration Manual.

110.06 Otolaryngologist means a professional who holds a valid certificate of

registration from the College of Physicians & Surgeons of Ontario and licensed

to practise medicine in Ontario, and to whom a certificate in the specialty of

otolaryngology has been issued by the Royal College of Physicians and

Surgeons of Canada.

110.07 Product Manual means, as appropriate:

Hearing Devices - Hearing Aids

Hearing Devices - Hearing Aids and FM Systems Approved Products

Hearing Devices - Hearing Implant Replacement Speech/Sound Processor

and/or

Hearing Devices - Telecommunication Devices

110.08 Speech-Language Pathologist means a professional who holds a valid

certificate of registration from the College of Audiologists and Speech-

Language Pathologists of Ontario (CASLPO) and licensed to practise in Ontario.

For more definitions, see the ADP Manual, Policy 110, Definitions

115 Roles and Responsibilities In the process of confirming eligibility for funding assistance, the Applicant/

Client, the Authorizer and the Vendor each have specific roles, certain rights and

responsibilities.

Additional information may be found in:

Policies and Procedures Manual for the Assistive Devices Program,

the Authorizer Agreement and


the Vendor Agreement.

115.01 Roles and Responsibilities of the Applicant or Client

Is responsible for arranging for an assessment with an Authorizer and

providing the necessary and accurate information to the Authorizer.

Will make an informed decision including, but not limited to, whether or not

to proceed with an Application Form, based on the accurate information

provided by the Authorizer and the Vendor during the assessment and the

ADP application process.

Provides the necessary and accurate information on the Application Form,

Section 1 – “Applicant’s Biographical Information”.

Should carefully review all the information on the Application Form,

including Section 3 – “Applicant’s Consent & Signature” prior to signing

this section.

Has the right to seek a second opinion if he/she disagrees with the

Authorizer’s assessment of his/her hearing device needs.

Is responsible for paying his/her portion of the cost for the Authorized

Device purchase directly to the Vendor.

After the Authorized Device is received, follows up with the Authorizer

and/or Vendor, as appropriate (e.g. regarding questions or difficulties with

the Authorized Device).

Obtains and provides quotations for repairs, as required.

115.02 Roles and Responsibilities of the Authorizer

Is the gatekeeper to the Program and assumes the leadership role in the

assessment process, confirmation of the Applicant’s eligibility, and

completion of the Application Form in a timely manner.

Will perform a thorough assessment to determine the Applicant’s eligibility

to apply for funding assistance, confirm the need for a hearing Device,


determine and authorize the appropriate hearing Device to meet the

Applicant’s hearing needs, taking into consideration the Applicant’s input

and environments where he/she normally functions

(e.g. home, school, work and community).

Careful consideration should be given to the projected needs of the

Applicant over the designated funding period of the Device.

Is an essential resource for the Applicant regarding the different types of

devices available to meet his/her hearing needs.

Will provide the Applicant with accurate information about ADP policies

and procedures, eligibility criteria and the estimated cost to purchase the

Authorized Device.

Will provide the Applicant with the applicant information sheet.

Will provide the Authorized Device specifications (includes make and

model) with the exception of TTYs.

Will provide the Applicant with a list of Vendors serving his/her community

and advise Applicants to consider more than one Vendor to compare

options, service plans and, if relevant, prices. Lists are available on the

ADP website.

Follows up with the Client after the Authorized Device has been provided

(for hearing aids - before the trial period ends) to ensure the Authorized

Device meets the Client’s hearing requirements. Exception: TTYs.

Refers an individual with suspected change in medical condition to the

individual’s Physician or Otolaryngologist.

Must not submit an Application Form to the Program for an individual who

does not meet the ADP eligibility criteria.

Maintains current knowledge of the Devices for which he/she is registered

to authorize.


Must continue to meet all conditions specified in his/her executed

Authorizer Agreement and all applicable Manuals.

Additional Information – Hearing Aids

The Authorizer informs the Applicant’s Physician or Audiologist, in writing,

regarding the Applicant’s audiological functioning and hearing aid

recommendation prior to the Physician or Audiologist completing the prescriber

section(s) of the Application Form.

The Authorizer may:

Authorize only, then provide the Applicant with a full list of Vendors in the

community. The Authorizer cannot refer the Applicant to a Vendor with

whom the Authorizer has a financial relationship, or

Authorize and dispense the Device, if the Authorizer is also a dispenser as

described in this Manual, Policy 1005, Staffing Requirements for Vendors.

In this instance, the Applicant must also see a Physician or Audiologist

(with whom the Authorizer/dispenser has no financial relationship) who

completes the prescriber section(s) of the Application Form, after receiving

the Authorizer’s report.

The Authorizer must attach a copy of the completed audiogram for both ears, or

the Auditory Brainstem Response (ABR) report and sound field test results

(applies to young children only) to the Application Form and gives it to the

Applicant to take to the Vendor.

The Authorizer must keep a copy of the Application Form and a copy of the

audiogram in the Applicant’s file. Audiograms must be signed and dated by the

Authorizer. Audiograms are valid for 6 months from the date that they are

completed, signed and dated.

115.03 Roles and Responsibilities of the Dispenser (For Hearing Aids)

Ensures that the Application Form has been fully completed by the

Applicant, prescriber and Authorizer.


Prepares the earmold impression and provides the fitting of the hearing aid

specified by the Authorizer.

Provides counseling and instructions necessary for the proper and

effective use, operation, care and maintenance of the hearing aid, earmold

and other related devices (e.g. FM systems), trouble-shoots and adjusts

the hearing aid, where appropriate, as part of the dispensing duties.

Provides the Applicant with a copy of the manufacturer's hearing aid

warranty.

Provides the Applicant with a minimum 30-day trial period, in writing, to

test the suitability of the hearing aid.

Notifies the Authorizer when the hearing aid has been dispensed and

sends the Applicant to the Authorizer for a hearing aid check before the

end of the trial period.

Must consult with the Authorizer before any changes or substitutions are

made to the Authorized Device (hearing aid), unless the Applicant seeks a

second opinion and the Applicant's hearing is re-tested and a new

assessment conducted by another Authorizer. In this instance, a new

Application Form must be completed by the Authorizer who retested the

Applicant, conducted the assessment and authorized the new hearing aid

(or FM system).

Maintains current knowledge of hearing aids listed in the Product Manual.

115.04 Roles and Responsibilities of the Vendor

Orders and provides prompt delivery of the Authorized Device specified on

the Application Form.

Provides counseling and instructions necessary for the proper and

effective use, operation, care and maintenance for all Devices sold.

Provides the Applicant with a fully itemized invoice for the Authorized

Device purchase together with a copy of the manufacturer’s warranty and

user manual, and collects from the Applicant the difference between the


total cost of the Authorized Device purchase and the ADP funding

contribution.

Submits the Application Form to the Program for processing.

Honours manufacturer’s warranties for the benefit of Clients and provides

after-sales service such as repair and maintenance services.

Keeps an adequate stock and maintains current knowledge of Devices

which they are authorized to sell.

Provides repair quotes, as necessary, to the Applicant and/or to the ADP.

Must continue to meet all conditions specified in their executed Vendor

Agreement and the Manuals.

Additional Information: TTY Vendors

For TTYs, the make and model is not specified by the Authorizer. The

Applicant selects the make and model of TTY and flashing signaling device

(if applicable) with the assistance of the Vendor’s trained staff.

The Vendor will work with the Applicant to ensure the choice of Device is

appropriate to meet the Applicant’s basic needs.

The Vendor must have a minimum of one TTY and one flashing signaling

device listed in the Product Manual for demonstration purposes.


Devices Covered

2


Part 2: Devices Covered by ADP

200 Devices Covered The hearing devices approved for ADP funding are listed in the Product

Manual. They are:

Hearing Aids/FM systems

Cochlear Implant Replacement Speech Processors

Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors

Teletypewriters and accompanying flashing signaling devices

In order to list devices with the Program, the manufacturer/distributor

responsible for the product in the Ontario market must warranty the product for

a minimum period of time as follows:

Hearing Aids - minimum 2 year warranty from date of fitting/ dispensing to

the Client.

FM systems – minimum 3 year warranty from date of dispensing to the

Client.

Cochlear Implant Replacement Speech Processors – minimum 3 year

warranty from date of initial activation of the Client’s device.

The procedure for manufacturers/distributors to apply for approval of a new

and/or updated product is available, upon request from the Program.

For generic hearing devices funded by the Program, the Vendor may only

provide Devices that have a minimum manufacturer/distributor warranty period

as follows:


Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors-

minimum 2 year warranty from date of initial stimulation of the Client’s

Device.

Teletypewriters and accompanying flashing signaling devices - minimum

1 year warranty from date the Device(s) is delivered to the Client.

205 Hearing Aids/FM Systems Hearing aids/FM systems are listed in the Product Manual.

210 Cochlear Implant Replacement Speech Processors Cochlear implant replacement speech processors are listed in the Product

Manual.

215 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors BAHA replacement sound processors are listed in the Product Manual.

220 Teletypewriters (TTY) for the Deaf or Speech Impaired Teletypewriters and flashing signaling devices are listed in the Product Manual.


225 Items Not Funded by ADP devices that are purchased from suppliers that are not registered with the

Ministry or that are located out-of-province

devices that are authorized before they are approved by the ADP for

listing in the Product Manual

extended warranties, service plans, handling fees

used devices, hearing tests

earmolds that are purchased separately from the hearing aid

flashing signaling devices purchased separately from the TTY

230 Repairs/Batteries The ADP does not provide funding towards the cost of repairs, maintenance

and/or batteries for any Device.


Applicant Eligibility for Hearing Devices

3


Part 3: Applicant Eligibility Criteria for Hearing Devices

300 Basic Hearing Device Requirements The Applicant must meet the eligibility criteria for Program benefits. See ADP

Manual, Policy 300, Eligibility Criteria for Program Benefits.

The Applicant must have a physical disability (documented hearing loss)

requiring the use of a hearing Device for a period of six months or longer.

In the opinion of a Physician or Audiologist, the Applicant has a documented

hearing loss sufficient to warrant the use of a hearing Device and requires the

use of a hearing Device to facilitate communication and/or enhance language

development on a continual or recurrent basis for a period of six months or

longer.

The Applicant must require the hearing Device(s) for his/her own personal use

and the intended use is to promote functional well-being in a variety of regular

daily activities and settings such as home, school, recreation, sports and work.

Basic Hearing Device Requirements – TTYs for the Speech-Impaired

The Applicant must meet the eligibility criteria for Program benefits. See ADP

Manual, Policy 300, Eligibility Criteria for Program Benefits.

The Applicant must have physical disability (speech impairment) requiring the

use of a Teletypewriter (TTY) for a period of six months or longer.

In the opinion of Physician or a Speech-Language Pathologist, the Applicant

has a speech impairment sufficient to warrant the use of a TTY and requires the


use of the TTY to facilitate communication on a continual or recurrent basis for

a period of six months or longer.

The Applicant must require the TTY for his/her own personal use and the

intended use is to promote functional well-being in a variety of regular daily

activities.

305 Non-Eligible Hearing Device Requirements The Program does not provide funding for Devices used intermittently or for

single purpose such as exclusive use for school, work, recreation or sport.

310 Individual Identified Ineligible by Authorizer An Application Form must not be submitted to the Program if, after assessing

the hearing requirements of the Applicant, the Authorizer confirms that the

individual does not meet the ADP eligibility criteria.

315 Applicant Identified Ineligible by ADP An Applicant may be deemed ineligible if the criteria for his/her access to the

Program are not met or where information supplied in connection with an

Application Form is insufficient, incomplete and/or inaccurate. In cases of

denial, the Vendor and the Applicant will be advised of the reason.


Confirmation of Eligibility for Devices Required

4


Part 4: Confirmation of Eligibility for Devices Required

To determine what Device(s) is clinically required and basic for ADP funding

purposes, the Authorizer must complete a comprehensive assessment. Once

the assessment has been completed and the Authorizer determines eligibility

for ADP funding assistance, the Application for Funding Hearing Devices may

be completed.

400 Hearing Aids The Applicant must have a documented hearing loss, and

There is documented evidence of the need for the hearing aid to meet

his/her basic daily listening needs based on established clinical tools.

405 FM Systems The Applicant must have a documented hearing loss.

There is documented evidence of the need for the FM system technology

to meet the Applicant’s basic listening needs such as, but not limited to,

subjective questionnaires. i.e. Client Oriented Scale of Improvement

(COSI), speech-in-noise testing and/or patient reports.

There is evidence of the Applicant’s ability to use the Device.

The benefits and limitations of FM technology have been explained to the

Applicant.


Validation and verification of FM system technology (as defined by

CASLPO) for the Applicant has occurred before the end of the trial period

of the Device.

Dispensing: Written documentation of education on use,

care/maintenance and minor trouble-shooting of the FM system as well as

warranty and trial period is to be signed by the Applicant before the end of

the trial period.

410 Cochlear Implant Replacement Speech Processor The Program does not provide funding for an initial speech processor.

Funding assistance towards a replacement speech processor may be provided

when all of the following criteria are met:

A minimum of 3 years has passed since the date of the cochlear implant

surgery.

The Applicant has not received funding from the Ministry in the past 3

years towards a cochlear implant speech processor.

The current cochlear implant speech processor is not working and

o cannot be repaired at a reasonable cost, or

o is no longer serviced by the manufacturer


415 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processor The Program does not provide funding for an initial sound processor or initial

abutment. Funding assistance towards a replacement sound processor and/or

replacement abutment may be provided when all of the following criteria are

met:

The Applicant must be over 5 years of age.

The Applicant must be diagnosed with one of the following:

o Unilateral or bilateral aural atresia;

o Congenital or acquired malformation of the auditory canal;

o Unilateral or bilateral chronic ear disease

A minimum of 5 years has passed since the date of the bone anchored

hearing aid surgery.

The Applicant has not received funding from the Ministry in the past 5

years towards a BAHA sound processor or an abutment.

The Applicant's current BAHA sound processor and/or abutment is not

working and

o cannot be repaired at a reasonable cost, or

o is no longer serviced by the manufacturer.


420 Teletypewriters (TTY) for the Deaf or Speech Impaired The Applicant has a hearing loss severe enough to impede normal use of

the telephone even with the use of a hearing aid and voice amplified

telephone and requires the use of a TTY and flashing signaling device. or

The Applicant has a speech impairment severe enough to impede normal

use of the telephone even with the use of an augmentative communication

aid, and requires the use of a TTY.


Service Delivery Models for Hearing Devices

5


Part 5: Service Delivery Models for Hearing Devices

500 Hearing Aids and FM Systems If the Applicant is a Child and applying for funding assistance towards a hearing

aid/FM system he/she must:

See a Physician or Audiologist (prescriber) who confirms that the Applicant

has a hearing loss sufficient to warrant the use of a hearing aid on a long

term basis as part of his/her total daily activities. Note: An

Otolaryngologist's assessment is required for a first-time Child

Applicant or for any Child whose hearing loss is not stable. The

Otolaryngologist completes the prescriber section (section 4) of the

Application for Funding Hearing Devices.

Be assessed by an Authorizer (that has a Children’s Hearing Aids

designation).

Have the hearing aids/FM system dispensed by a hearing aid dispenser.

Purchase the hearing aids from a Vendor (that has a Hearing Aids

designation).

If the Applicant is an Adult and applying for funding assistance towards a

hearing aid/FM system then he/she must:

See a Physician or Audiologist (prescriber) who confirms that the Applicant

has a hearing loss sufficient to warrant the use of a hearing aid on a long

term basis as part of his/her total daily activities.

Be assessed by an Authorizer (that has an Adults Hearing Aids

designation).


Have the hearing aids/FM system dispensed by a hearing aid dispenser.

Purchase the hearing aids/FM system from a Vendor (that has a Hearing

Aids designation).

FM systems must be authorized by an Authorizer who is an Audiologist.

500.01 Prescription of a Hearing Aid

Prescription of a hearing aid is a controlled act under the Regulated Health

Professions Act. A prescriber for a hearing aid is a family physician (general

practitioner), or an Otolaryngologist, or an Audiologist.

500.02 Conflict of Interest

If the Physician has a financial relationship with the Authorizer, dispenser or

Vendor, the Physician cannot complete the prescriber section (section 4) of the

Application for Funding Hearing Devices. Another Physician or Audiologist who

does not have a financial relationship with the Authorizer, dispenser or Vendor

must complete the prescriber section (section 4) of the Application for Funding

Hearing Devices.

If the Audiologist has a financial relationship with the Authorizer, dispenser or

Vendor, the Audiologist cannot complete the prescriber section (section 4) of the

Application for Funding Hearing Devices. Another Audiologist or Physician who

does not have a financial relationship with the Authorizer, dispenser or Vendor

must complete the prescriber section (section 4) of the Application for Funding

Hearing Devices.

500.03 Hearing Aids/FM Systems Assessment Process

In order to determine what Device(s) is clinically required and basic for ADP

funding purposes, the Authorizer must complete a thorough assessment. The

assessment must include an audiogram for both ears.

The audiogram must include:

Pure tone air and bone conduction thresholds.

Speech recognition threshold (formerly speech reception threshold)


Speech recognition score (formerly discrimination)

Tolerance/uncomfortable level

Most comfortable level

Immittance (not mandatory for Adults)

Masking where necessary

Authorizer signature and date

For young children (e.g. 0 to 36 months), complete audiograms may be

contingent upon the age and ability of the child to respond. In cases where a

complete audiogram cannot be obtained, results from auditory brainstem

response audiometry or sound field testing may be used to authorize a hearing

aid until a complete audiogram can be conducted.

The assessment of a child 0 - 36 months must include at least soundfield testing

and immittance testing.

Regular audiologic reviews, at least every six months, are recommended until a

complete audiogram can be obtained.

500.04 Authorizer Equipment Requirements

Authorizers must have the following testing equipment:

For Children:

A sound isolating booth meeting ANSI standards with visual reinforcement

audiometry (VRA) capabilities.

A clinical audiometer capable of air, bone, masking, speech recognition

and sound field testing.

A middle ear analyzer (impedance bridge).


The following is recommended and encouraged:

A probe tube microphone.

All test equipment must be calibrated at least once a year and meet ANSI

specifications. Test facilities and instrumentation must be CSA/Ontario Hydro

approved.

For Adults:

A test environment in which the ambient noise levels do not exceed 40dBA

SPL.

A clinical or portable audiometer capable of air, bone, masking and speech

recognition.

The following are recommended and encouraged:

An impedance bridge.

A sound treated room meeting ANSI standards.

Equipment must be calibrated at least once a year to meet ANSI specifications.

Test instrumentation must be CSA/Ontario Hydro approved.

505 Cochlear Implant Replacement Speech Processor The Applicant must:

See an Otolaryngologist (prescriber).

Be assessed by an Authorizer (with a Cochlear Implant Replacement

Speech Processor designation).

Purchase the speech processor from a Vendor (with a Cochlear Implant

Replacement Speech Processor designation).


Return to the Authorizer for mapping of the Authorized Device.

510 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processor

If a replacement sound processor and abutment are required, then the Applicant

must:

See Otolaryngologist (prescriber) actively engaged in the BAHA program

at the hospital.

Be assessed by an Authorizer (with a BAHA Replacement Sound

Processor designation).

Purchase the sound processor from a Vendor (with a BAHA Replacement

Sound Processor designation).

If only a replacement sound processor is required, then the Applicant must:

Be assessed by an Authorizer (with a BAHA Replacement Sound


Purchase the sound processor from a Vendor (with a BAHA Replacement

Sound Processor designation).

If an abutment only is required, then the Applicant must:

See an Otolaryngologist (prescriber) actively engaged in the BAHA

program at the hospital who will determine if a replacement abutment is

required.

Purchase the abutment from a Vendor (with a BAHA Replacement Sound


Return to the Otolaryngologist (prescriber) for replacement of the device.


515 Teletypewriters (TTY) for the Deaf or Speech Impaired If the Applicant is deaf, then he/she must:

Be assessed by either a Physician or an Audiologist Authorizer (with a

Hearing Aids designation) to determine eligibility.

Purchase the TTY and accompanying flashing signaling device from a

Vendor (with a TTY designation).

Note: A flashing signaling device must be purchased at the same time as the

TTY. The ADP does not fund flashing signaling devices separately.

If the Applicant has a speech impairment, then he/she must:

Be assessed by either a Physician or a Speech-Language Pathologist

Authorizer (with a Communication Aids designation) to determine eligibility.

Purchase the TTY from a Vendor (with a TTY designation).

Note: Speech impaired Applicants are not eligible for funding towards the

flashing signaling device.


Device Eligibility

6


Part 6: Device Eligibility

600 Number of Devices Funded and Designated Funding Periods Hearing Aids/FM Systems

Based on the Authorizer’s assessment, the Applicant may require more than

one Device.

ADP funding assistance may be requested for:

One or two hearing aids (one for each ear)

One FM system

Types of hearing aids funded by the Program include: behind the ear; in the ear;

in the canal; and completely in the canal.

A CROS or BICROS hearing aid is considered one hearing aid. When a hearing

aid is modified to make it into a CROS or BICROS hearing aid, include the

hearing aid with CROS/BICROSs option/modification as part of the fully

itemized invoice provided to the Applicant.

Cochlear Implant Replacement Speech Processor

ADP funding assistance may be requested for a cochlear implant replacement

speech processor.


Bone Anchored Hearing Aid (BAHA) Replacement Sound Processor

ADP funding assistance may be requested for a BAHA replacement sound

processor, and/or an abutment, if required.

Teletypewriters (TTY) for the Deaf or Speech Impaired

If the Applicant is hearing impaired, ADP funding assistance may be requested

for one TTY and one accompanying flashing signaling device.

If the Applicant is speech impaired, ADP funding assistance may be requested

for one TTY.

605 Designated Funding Periods The designated funding period identifies how long the hearing device should, in

most cases, remain in good repair under normal use. The Program does not

automatically provide funding towards a replacement hearing device at the end

of the designated funding period.

The following are the designated funding periods:

Hearing Aids/FM systems – 5 years

Cochlear Implant Replacement Speech Processors – 3 years

BAHA Replacement Sound Processors – 5 years

Teletypewriters – 5 years


610 Request for a Replacement Device The ADP may provide funding during or following the designated funding period

for a new hearing Device, under certain circumstances.

Significant Change in Hearing (Hearing Aids)

If during or following the designated funding period, an Otolaryngologist

determines that the Client has experienced a significant change in hearing in

the ear for which the original ADP funded hearing aid was authorized, and the

hearing aid is no longer suitable for the Client, the Client can apply for funding

assistance towards the cost of a new hearing aid.

A significant change in hearing is defined a minimum 20 dB change in three or

more of the following speech frequencies: 500 Hz, 1000 Hz, 2000 Hz, or 3000

Hz in the ear for which the original hearing aid was authorized.

Change in Medical Condition

If during or following the designated funding period, an Otolaryngologist

determines that the Client has experienced a significant change in medical

condition in the ear for which the original hearing aid was authorized, and the

hearing aid is no longer suitable for the Client, then the Client can apply for

funding assistance towards the cost of a new hearing aid.

Physical Growth/Atrophy

If during or following the designated funding period, the Authorizer determines

through an assessment that the previously funded hearing Device is no longer

suitable for the Client due to growth/atrophy, the Client can apply for funding

assistance towards the cost of a new hearing Device.


Normal Wear

If during or following the designated funding period, the hearing Device is no

longer working, not covered under warranty, and the cost to repair it is more

than one third of the original purchase price, the Client can apply for funding

assistance towards the cost of a new hearing Device if all eligibility criteria are

met. The Vendor must submit a quotation showing the estimated cost of repairs

and/or copies of repair bills together with a newly completed Application Form.

Lost Devices

The ADP will not provide funding for lost hearing Devices within the designated

funding period. Clients are encouraged to purchase insurance to cover such

situations. If the designated funding period has passed, the ADP will provide

funding for a replacement if all other eligibility criteria are met. The Vendor must

submit a Vendor quote showing: “Not Repairable- Aid Lost” together with the

newly completed Application Form.


Funding and Payment

7


Part 7: Funding and Payment

700 Policies No payment of an approved Device shall be made to anyone other than a

Vendor. Lists of Vendors in specific geographic areas can be obtained from the

ADP website.

705 Approved Price for Hearing Aids (Includes FM Systems) The Approved Price for all hearing aids /FM systems is the manufacturer’s

invoice price to the Vendor for the hearing aids/FM systems.

710 Funding Amount for ADP Clients Hearing Aids/FM Systems

For eligible Applicants, the ADP will contribute 75 percent up to a maximum of

$500 towards the cost of a monaural hearing aid fitting, 75 percent up to a

maximum of $1000 towards the cost of a binaural hearing aid fitting, and 75

percent up to maximum of $1350 towards the cost of an FM system.

ADP's contribution includes funding towards the cost of the eligible hearing aid

listed in the Product Manual, earmold and applicable dispensing fee.


For FM systems, the ADP's contribution includes funding towards the cost of

the eligible FM system listed in the Product Manual and one applicable

dispensing fee.


For eligible Applicants, the ADP will contribute 75 percent of the manufacturer’s

invoice price in Canadian dollars up to a maximum of $5444.


For eligible Applicants who require a replacement sound processor with

abutment, the ADP will contribute 75 percent of the manufacturer’s invoice

price in Canadian dollars up to a maximum of $3,900.

For eligible Applicants who require a replacement sound processor only, the

ADP will contribute 75 percent of the manufacturer’s invoice price in Canadian

dollars up to a maximum of $3,000

For eligible Applicants who require a replacement abutment only, the ADP will

contribute 75 percent of the manufacturer’s invoice price in Canadian dollars up

to a maximum of $900.

Teletypewriters (TTY) for the Deaf or Speech Impaired

Teletypewriter


$393.75 for a printing TTY and 75 percent up to a maximum of $243.75 for a

non-printing TTY.

Flashing Signaling Device


$49.50.


715 Funding for Ministry of Community and Social Services (MCSS) Benefits Recipients Co-payment for Applicants receiving Social Assistance Benefits

Ontario Works (OW)

Ontario Disability Support Payment (ODSP)

Assistance to Children with Severe Disabilities (ACSD)

715.01 Cochlear Implant Replacement Speech Processor

For Clients receiving social assistance benefits through OW, OSDP or ACSD

as of the date reviewed and approved by the Authorizer, ADP will pay 100

percent of the manufacturer’s invoice price in Canadian dollars up to a

maximum of $7,258.67.

715.02 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processor

For Clients receiving social assistance benefits through OW, ODSP or ACSD

as of the date reviewed and approved by the Authorizer, ADP will pay

100 percent of the manufacturer’s invoice price in Canadian dollars up to a

maximum of $4,000 towards the sound processor only, 100 percent up to a

maximum of $5,200 toward the sound processor with abutment, or 100 percent

up to a maximum of $1,200 for the abutment only.

715.03 Teletypewriters (TTY) for the Deaf or Speech Impaired

For Clients receiving social assistance benefits through OW, ODSP or ACSD

as of the date reviewed and approved by the Authorizer, ADP will pay:


100 percent up to a maximum of $525 towards the cost of a printing TTY,100

percent up to a maximum of $325 for a non-printing TTY and 100 percent up to

a maximum of $66 towards the cost of the flashing signaling device.

720 Delivery of Device The Vendor will provide the Authorized Device together with a fully itemized

invoice to the Client, advise the Client regarding the warranty and after-

purchase services offered, and provide a copy of the manufacturer’s warranty

and user manual for the Device.

In addition to the above, Hearing aid Vendors will ensure that the Client is

provided with a minimum 30-day trial period (in writing) to test the suitability of

the hearing aid(s)/FM system.

725 Expiry Date of the Application for Funding Hearing Devices The Application Form is considered current and valid for one (1) year from the

Authorizer assessment date.

Note: The expiry date will NOT be extended. After the expiry date, a new

assessment must be completed and a new Application Form must be submitted

to the Program.

730 Hearing Aids/FM System Dispensing Fee Charges If the dispenser is a member of the College of Audiologists and Speech-

Language Pathologists of Ontario (CASLPO), the Applicant cannot be charged


more than the Ontario Association of Speech-Language Pathologists and

Audiologists (OSLA) recommended dispensing fee listed in the OSLA

Suggested Fee Schedule.

If the dispenser is a member of the Association of Hearing Instrument

Practitioners of Ontario (AHIP), the Applicant cannot be charged more than the

AHIP recommended dispensing fee listed in the AHIP Recommended Fee

Guide.

The only exception to this policy, for both members of CASLPO and members

of AHIP, is if the Vendor notifies the Applicant in writing in advance and the

Applicant agrees in writing. The Vendor must also make a special notation on

the ADP invoice and Applicant's invoice informing the Applicant of the amount

charged above the recommended fee guide.

735 Pricing of Other Items For earmolds, Vendors are encouraged to charge no more than the amounts

listed in the respective professional association fee guide.

If the Vendor invoices the Applicant an amount in excess of the applicable fee

guide, the Vendor must make a special notation on the ADP invoice and the

Applicant's invoice, in writing, for each item, informing the Applicant of the

amount charged above the applicable professional association fee guide.

For items such as audiometric fees, service fees, options/accessories, parts list

and service agreements, ADP strongly recommends that Vendors charge no

more than the applicable professional association fee guide.


Invoicing Procedures

8


Part 8: Invoicing Procedures

800 Invoice Processing Refer to the ADP Manual, Part 9, Invoicing Processing and Payment, for

details.

Note: ADP Vendors for hearing Devices are not required to submit the invoice.

The original invoice is kept in the Applicant’s file together with a copy of the

Application Form. The Program may request a copy of the invoice.

805 ADP Processing Errors In the event of an ADP processing error being identified following funding

approval, the ADP will co-operate with the Authorizer, Vendor and Client to

make any necessary corrections.

The Vendor must notify the ADP in writing of the error(s) along with a request

for the approval to be amended.

810 Authorizer Errors & Omissions In the event of an Authorizer error and/or omission being identified following

funding approval, the ADP will co-operate with the Authorizer to make any

necessary corrections.

The Authorizer must return a copy of the Application Form to the ADP with the

errors highlighted along with a request for the approval to be amended.


815 Applicant Return of Hearing Devices If the Applicant returns the hearing Device and does not get another one before

the end of the trial period, the Vendor must reimburse the Applicant any

amounts paid minus a reasonable handling fee, if applicable, and reimburse the

Ministry any funding contributions paid to the Vendor.

The credit note must be issued within 15 days from the date the Applicant

returns the hearing Device and sent to:

Ministry of Health and Long-Term Care

Financial Management Branch, Program Payments

P.O. Box 48

49 Place D’Armes, 2nd Floor

Kingston, Ontario K7L 5J3

820 Update Policy If the Applicant returns the hearing Device and gets another within the trial

period, the Vendor must ensure that ADP receives a written update regarding

the Applicant's hearing Device substitution. The update must be signed by the

Authorizer confirming the substitution.

Send the update to:

Ministry of Health and Long-Term Care

Assistive Devices Program

5700 Yonge St. 7th Floor

Toronto, ON M2M 4K5


Authorizers

9


Part 9: Authorizers

900 Authorizer Status Audiologists wishing to be registered with the Program for Hearing Aids,

Cochlear Implant Replacement Speech Processors or BAHA Replacement

Sound Processors must meet the requirements for the respective type of Device.

Hearing instrument specialists wishing to be registered with the Program for

Hearing Aids must meet the requirements for Hearing Aids.

905 Requirements for Authorizer Status 905.01 Hearing Aids: Children (18 Years of Age or Younger)

An Audiologist who holds a valid certificate of registration from the College of

Audiologists and Speech-Language Pathologists of Ontario (CASLPO) and

licensed to practise in Ontario.

905.02 Hearing Aids: Adults (19 Years of Age or Older)

An Audiologist who holds a valid certificate of registration from the College

of Audiologists and Speech-Language Pathologists of Ontario (CASLPO)

and licensed to practise in Ontario.

A hearing instrument specialist who can provide:

o Proof of successful completion of a hearing instrument specialist

program in Ontario that is recognized by the Ministry of Training,

Colleges and Universities and

o Proof of successful completion of an apprenticeship program

consisting of a minimum of 1000 supervised internship hours


approved by the Association of Hearing Instrument Practitioners of

Ontario (AHIP) and

o Proof that he/she is a practicing member in good standing of AHIP.

A person other than (a) or (b) who has passed the ADP Level II (Authorizer)

exams and was grandfathered into the hearing aid category as an

Authorizer and

o Proof that he/she is a practicing member in good standing of AHIP.

905.03 Who Can Authorize FM Systems

Only Authorizers for Hearing Aids who are Audiologists can authorize FM

systems.

905.04 Cochlear Implant Replacement Speech Processors

An Audiologist who:

holds a valid certificate of registration from the College of Audiologists and

Speech-Language Pathologists of Ontario (CASLPO) and licensed to

practise in Ontario; and

is employed at a hospital with a dedicated cochlear implant program; and

has received relevant training (including manufacturer training); and

has experience working with cochlear implant devices and working with

cochlear implant recipients.

905.05 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors

An Audiologist who:

holds a valid certificate of registration from the College of Audiologists and

Speech-Language Pathologists of Ontario (CASLPO) and licensed to

practise in Ontario; and


has received relevant training (including manufacturer training); and

has experience working with BAHA devices and working with BAHA

recipients.


For Persons Who Are Deaf

An Audiologist who holds a valid certificate of registration from the College of

Audiologists and Speech-Language Pathologists of Ontario (CASLPO) and

licensed to practise in Ontario, and who is registered as an Authorizer for

Hearing Aids.

For Persons Who Are Speech Impaired

A Speech-Language Pathologist who holds a valid certificate of registration from

the College of Audiologists and Speech-Language Pathologists of Ontario

(CASLPO) and licensed to practise in Ontario, and who is registered as an

Authorizer for Communication Aids.

910 General Authorizer Policies Detailed information about Authorizer registration, policies and procedures, are

found in the ADP Manual, Part 4, General Authorizer and Vendor Policies and

Part 5, Authorizers.


Vendors

10


Part 10: Vendors

1000 Vendors Status Vendors wishing to submit a request for funding to the Ministry for hearing

Devices must be registered as Vendors for the appropriate category of hearing

Devices. There are four separate categories of hearing Devices



Hearing Aids

Teletypewriters for the Deaf or Speech Impaired

Vendors applying for registration status must be active retailers. Vendors must

complete the Vendor application package and return it to the Program together

with the required documentation/attachments.

1000.01 Manufacturers as Vendors (Hearing Aids)

New and existing manufacturers operating as Vendors must demonstrate an

ability to meet the requirements of Policies 600 and 605 in the ADP Manual.

Despite Policy 605 in the ADP manual, any manufacturer may apply for Vendor

registration status for hearing aids.


1005 Staffing Requirements for Vendors 1005.01 Hearing Aids – Dispensers and Equipment Requirements

Vendors must employ a minimum of one dispenser to provide the hearing aid

fittings and dispense FM systems for Applicants. The dispenser must be one of

the following:

A person who is:

A successful graduate of a hearing instrument specialist program in

Ontario that is recognized by the Ministry of Training, Colleges and

Universities and A practicing membership in good standing of the

Association of Hearing Instrument Practitioners of Ontario (AHIP).

An Audiologist who holds a valid certificate of registration from the College

of Audiologists and Speech-Language Pathologists of Ontario (CASLPO)

and licensed to practise in Ontario.

A graduate of the former George Brown College Hearing Instrument

Dispenser Program who is a practicing member in good standing of the

Association of Hearing Instrument Practitioners of Ontario (AHIP).

A graduate of the former Sheridan College Hearing Aid Specialist

Program who is a practicing member in good standing of the Association

of Hearing Instrument Practitioners of Ontario (AHIP).

A person who passed the ADP Level I (dispenser) exam who is a

practicing member in good standing of the Association of Hearing

Instrument Practitioners of Ontario (AHIP). Applies to grandfathered

dispensers only.


Equipment Requirements for Dispensers:

The following minimum dispensing equipment must be used by dispensers for

cleaning, servicing and testing hearing aids and earmolds:

A stethoscope

An otoscope

A high speed dremel-type drill, and

Heating and modifying tools

The following are recommended and encouraged:

An electroacoustic hearing aid analyzer, and

An ultrasonic cleaner

1005.02 Cochlear Implant Replacement Speech Processors

Vendors must employ individuals with training and experience working with the

Devices and working with cochlear implant recipients.

1005.03 Bone Anchored Hearing Aid (BAHA) Replacement Sound Processors

Vendors must employ individuals with training and experience working with the

Devices and working with BAHA recipients.


Vendors must employ individuals who are knowledgeable about the makes and

models of TTYs and flashing signaling devices, can demonstrate the devices to

individuals (explain how they work and the different features) and have

experience working with deaf/hearing impaired and/or speech impaired

individuals.


1010 Additional Requirements – Hearing Aid Vendors Hearing Aid Vendors must:

Dispense a minimum of four different manufacturers brands of hearing

aids listed in the Hearing Aids Product Manual.

Ensure that after the hearing aids and/or FM systems are dispensed, the

Applicants are provided with a minimum 30-day trial period (in writing) to

test the suitability of the hearing aids/ FM systems.

Notify the Program “Registration Unit” in writing within ten days of an

employee who is an Authorizer ceasing to be an employee and a person

who is an Authorizer becoming an employee.

1015 General Vendor Policies Detailed information about Vendor registration and policies and procedures is

found in the ADP Manual in the following areas:

Part 4, General Authorizer and Vendor Policies;

Part 6, Vendors;

Part 7, Personal Health Information, and

Part 9, Invoice Processing and Payment.

Note in Particular:

i. Policy 405, Conflict of Interest

ii. Policy 415, Advertising


iii. Policy 420, Referrals

iv. Policy 600, Applying for Registration – New Vendor

v. Policy 601, Applying for Registration – Additional Vendor Location or

Additional Category of Devices

vi. Policy 602, Maintaining Registration as a Vendor

vii. Policy 615, Relationships of Hospitals and Vendors

viii. Policy 620, Vendors Sharing Proceeds with Long-Term Care Homes

ix. Policy 640, Informing Persons of the Program

x. Policy 660, Refusal to Supply for Safety Reasons

xi. Policy 665, Warranties of Purchased Devices

xii. Policy 670, Repairs of Purchased Devices

xiii. Policy 700, Protection of Personal and Personal Health information

xiv. Policy 905, Rebates

The ADP Manual is available at:

http://www.health.gov.on.ca/en/pro/programs/adp/policies_procedures_manual

s/docs/pp_adp_manual.pdf

http://www.health.gov.on.ca/en/pro/programs/adp/policies_procedures_manuals/docs/pp_adp_manual.pdf

http://www.health.gov.on.ca/en/pro/programs/adp/policies_procedures_manuals/docs/pp_adp_manual.pdf

Documents

Hearing Devices Policy and Administration Manual€¦ · Hearing Devices Policy and Administration Manual 8 February 2016 Hearing Aids; Teletypewriters (TTY) for the Deaf or Speech